Provider Demographics
NPI:1962068338
Name:GUERRERO, MYRANDA JAYDE
Entity type:Individual
Prefix:MRS
First Name:MYRANDA
Middle Name:JAYDE
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MIRANDA
Other - Middle Name:JADE
Other - Last Name:MCALPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:108 HEALEY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4073
Mailing Address - Country:US
Mailing Address - Phone:256-777-8295
Mailing Address - Fax:
Practice Address - Street 1:1222 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4351
Practice Address - Country:US
Practice Address - Phone:256-341-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF05190115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily